Characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis

Background: Parenteral iron is integral in the treatment of anaemia of chronic kidney disease patients on haemodialysis (HD). However, increased liver iron concentration (LIC) can result from such treatment, and this correlates poorly with serum ferritin or transferrin saturation values. It is uncle...

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Main Authors: Holman, R., Olynyk, John, Kulkarni, H., Ferrari, P.
Format: Journal Article
Published: Wiley-Blackwell 2017
Online Access:http://hdl.handle.net/20.500.11937/46153
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author Holman, R.
Olynyk, John
Kulkarni, H.
Ferrari, P.
author_facet Holman, R.
Olynyk, John
Kulkarni, H.
Ferrari, P.
author_sort Holman, R.
building Curtin Institutional Repository
collection Online Access
description Background: Parenteral iron is integral in the treatment of anaemia of chronic kidney disease patients on haemodialysis (HD). However, increased liver iron concentration (LIC) can result from such treatment, and this correlates poorly with serum ferritin or transferrin saturation values. It is unclear whether increased cardiac iron concentration also occurs in this setting. We aimed to evaluate the relationship of intravenous iron supplementation to hepatic and cardiac iron deposition in chronic HD subjects. Methods: A cohort of 10 patients on chronic HD for at least 1 year underwent MRI-based quantitation of hepatic and cardiac iron content to evaluate the relationship between intravenous iron supplements and hepatic and cardiac iron deposition. The results were compared against the cumulative parenteral iron dose and serum iron markers. Results: The median age was 61 years (95% confidence interval (CI) 50–71), HD time 2.5 years (95%CI 2.0–5.3) and cumulative iron dose 4300 mg (95%CI 2110–9045). Hepatic iron concentration was elevated in eight of 10 subjects (median 46 mmol/kg, range 31–76). Cardiac iron levels were within the reference range in all subjects. There was poor correlation between conventional haematinic values and either LIC or cardiac iron levels. None of the study subjects exhibited elevated cardiac iron concentration. Conclusion: Whilst HD patients receiving standard parenteral iron therapy have elevated LICs, this is not associated with cardiac iron deposition. Transferrin saturation and serum ferritin levels are poor markers of either liver or cardiac iron deposition in HD subjects.
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spelling curtin-20.500.11937-461532018-03-29T09:07:45Z Characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis Holman, R. Olynyk, John Kulkarni, H. Ferrari, P. Background: Parenteral iron is integral in the treatment of anaemia of chronic kidney disease patients on haemodialysis (HD). However, increased liver iron concentration (LIC) can result from such treatment, and this correlates poorly with serum ferritin or transferrin saturation values. It is unclear whether increased cardiac iron concentration also occurs in this setting. We aimed to evaluate the relationship of intravenous iron supplementation to hepatic and cardiac iron deposition in chronic HD subjects. Methods: A cohort of 10 patients on chronic HD for at least 1 year underwent MRI-based quantitation of hepatic and cardiac iron content to evaluate the relationship between intravenous iron supplements and hepatic and cardiac iron deposition. The results were compared against the cumulative parenteral iron dose and serum iron markers. Results: The median age was 61 years (95% confidence interval (CI) 50–71), HD time 2.5 years (95%CI 2.0–5.3) and cumulative iron dose 4300 mg (95%CI 2110–9045). Hepatic iron concentration was elevated in eight of 10 subjects (median 46 mmol/kg, range 31–76). Cardiac iron levels were within the reference range in all subjects. There was poor correlation between conventional haematinic values and either LIC or cardiac iron levels. None of the study subjects exhibited elevated cardiac iron concentration. Conclusion: Whilst HD patients receiving standard parenteral iron therapy have elevated LICs, this is not associated with cardiac iron deposition. Transferrin saturation and serum ferritin levels are poor markers of either liver or cardiac iron deposition in HD subjects. 2017 Journal Article http://hdl.handle.net/20.500.11937/46153 10.1111/nep.12735 Wiley-Blackwell restricted
spellingShingle Holman, R.
Olynyk, John
Kulkarni, H.
Ferrari, P.
Characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis
title Characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis
title_full Characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis
title_fullStr Characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis
title_full_unstemmed Characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis
title_short Characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis
title_sort characterization of hepatic and cardiac iron deposition during standard treatment of anaemia in haemodialysis
url http://hdl.handle.net/20.500.11937/46153